Daily Energy & Activity Tracking Form
Welcome! You have elected to participate in a detailed energy analysis in order to discover your true daily caloric consumption.  The goal of such an analysis is to derive a caloric value that can serve as an anchor for your weight management goals.  Armed with this value, we can create a customized dietary plan that will help you achieve your goals.
Note that this is a fairly difficult task and will require a fair amount of attention.  For best results, we suggest that you perform this analysis on two weekdays and one weekend day and then have one of our staff members enter your data and average your results.
IMPORTANT: Please strive to be as accurate as possible!
Instructions: Log the start and end time each time your activity level changes throughout the day.  For each activity period, enter the activity level code that characterizes that period using the codes shown in the table below.  Note that your last entry should end with “Midnight”. 
Activity categories: 
Activity Code	Description	
1	Sleeping, resting in bed	
2	Sitting, eating, listening, writing, computer work	
3	Light activity while standing	
4	Slow walking, driving, dressing, showering	
5	Light manual work, chores, light walking     	
6	Leisure activities, recreational sports	
7	Manual work at a moderate pace	
8	Leisure and sport activities of higher intensity	
9	Intense manual work or exercise, competition	

Example:
Name:    John Sample                          ID:    123                   Date:    6/6/04            Weekday?
	(circle)
Start	End	Level		Start	End	Level		Start	End	Level	

Midnight	7:30	    1	   	7:30	8:17	  4	   	8:17	8:35	  2	

8:35	9:00	    4	   	9:00	9:12	  5	   	9:12	11:50	  2	
Etc…
Activity Tracking Data Entry Form
Name: _________________________      ID: _________     Date: ____________      Weekday?
	(circle)
Start	End	Level		Start	End	Level		Start	End	Level	

Midnight